Lower BMI and still approved by US doc and insurance?

[mommakatx2 0]

I have a couple questions for anyone who has had a lower BMI and been approved by their insurance.

How low was your BMI?

Did you have any of the co-morbidities generally required (diabetes, hypertension, arthritis, etc.)

Was it difficult to get approved?

Did you meet resistance from physicians regarding your desire to be banded?

I have my first appointment on Wednesday with a family care physician to discuss my weight and my desire for the lap band. I don't know what to expect but I'm feeling like he or she will look at me and laugh. I have been told so many times to just "go on a diet" by doctors. Well, I've been on just about every diet under the sun, and I've been fat my entire life (even as a child). I'm ready to take a more permenant step towards weightloss, but I'm worried that docs won't be very supportive with my "low" BMI.

Any experiences/stories would be great.

[VegasGrace 1]

How low was your BMI?

30

Did you have any of the co-morbidities generally required (diabetes, hypertension, arthritis, etc.)

Yes. HBP, chronic back pain, suspected sleep apnea

Was it difficult to get approved?

No

Did you meet resistance from physicians regarding your desire to be banded?

physicianS? I only spoke with one about it...my surgeon. So, no, I didn't meet resistance. When I spoke about it with primary care...they didn't know what it was.

I'd bypass all the red tape. If you think you qualify for the band... who is your primary care to decide if you should or shouldn't have it? You are the one who decides...and your surgeon.

Oh, but if you are wanting your insurance to pay for it...you may have to jump through hoops...but so many on this forum have had insurance to cover it.

Good luck!

[mommakatx2 0]

Thank you for your reply.

We are military and I'm hoping to get approved through Tricare. However I have to see a family physician before I can see a surgeon--they have to put in a referral for me.

I'm just wondering if it's possible to be covered and approved by insurance even without a 40 BMI.

[snowbird 2]

My BMI was 35. I have Blue Cross Blue Shield federal employees' insurance. My co morbidities were not so severe as to be considered life threatening at this point: BP was a bit high, blood sugar levels a bit elevated but not diabetic, a tendency to hyperextend my knees due to a congenital problem that was worsened by my weight, and acid reflux. Since I went to Mexico I had to pay first, but my insurance reimbursed me everything except about $80.

I went to a primary care physician who was my daughter's doctor also, and she had lost nearly 100 pounds with the band, so he was very enthusiastic and supported my desire for the band totally.

[Heatherz88 2]

<p>

I have a couple questions for anyone who has had a lower BMI and been approved by their insurance.</p> <p> </p> <p>How low was your BMI?</p> <p> </p> <p>Did you have any of the co-morbidities generally required (diabetes, hypertension, arthritis, etc.)</p> <p> </p> <p>Was it difficult to get approved?</p> <p> </p> <p>Did you meet resistance from physicians regarding your desire to be banded?</p> <p> </p> <p>I have my first appointment on Wednesday with a family care physician to discuss my weight and my desire for the lap band. I don't know what to expect but I'm feeling like he or she will look at me and laugh. I have been told so many times to just "go on a diet" by doctors. Well, I've been on just about every diet under the sun, and I've been fat my entire life (even as a child). I'm ready to take a more permenant step towards weightloss, but I'm worried that docs won't be very supportive with my "low" BMI.</p> <p> </p> <p>Any experiences/stories would be great.

</p> <p>Mine was 36 when i had my surgery after my pre-op diet. and i started out at 232 and im down to 200 today!</p>Oh and my co-morbidities were one kidney, family history of kidney desease, family history of diabetes, vericose veins.

[StLouisGal 1]

Take as much information as you can to the primary so that you can explain it to them if you have to. They are going to have to write the referral to get you approved. The more you know about the procedure and the benefits of it, the more chance you will have to get the primary to approve it and send the referral. I am pretty sure Tricare does cover it but not in all facililties so you may have to hunt around for a facility that does the band under Tricare. Good luck to you.

[4jin 0]

I too had to have a referral from my family doc.

That is the easy part...

the harder part was getting the letter from the family doc to my surgeon.

At least I thought it was going to be hard, what I did was as my surgeon's office suggested...I did all the required steps once I completed that I went to see my family doctor...he had by then already received psych eval, lab results, etc..so he saw I was committed to working hard. He heard my concerns and easily agreed this was a good choice for me. And aggreed to do the letter.

It was much easier than I thought....

just pray....and it will happen..

I have heard of other doctors deny and say lets diet once more..but It is really your decision if that is the case...I personally would find another family doc that would support my decisions....

[sundance 0]

snowbird,

how did you submit everything to BCBS. I went to Dr. Ortiz in Mexico also. I have BCBS and my BMI was 35 too. I would like to submit everything but do not know how. Did Dr. Ortiz give you some kind of detailed billing. I just got a sheet of paper that says $8500 for everything.

I would really appreciate any information you can give me.

[mommakatx2 0]

Thanks for the replies! I am prepared to go in with an armload of information. I am a registered nurse so I understand how most physicians think and work.

I am going to call Tricare tomorrow and get their requirements. I know they now cover it, but I'm not sure of the stipulations.

I just thought that maybe it would be hard to get approved in the US with a BMI under 40.

Unfortunately in the military, you don't always get to choose your doctors. You see whomever is available that day. I've rarely seen the same doctor twice in one year, which makes follow-up care difficult but may be to my advantage as far as my history goes. They can look back at my records and see that I've been seen for my weight before, that I've lost weight and regained it.

I'm just hoping beyond all hopes that this works for me.

[snagrammy 0]

Lots of luck to you! I'm confident it will work out for you!

I had a BMI of 36, have an HMO, but told my primary care that I wanted to see a Bariatric surgeon to discuss the possibility of surgery. I got the referral without a problem. Had an appointment at Barix the following week (10/24/07), had my insurance approval by 11/05/07 and will have my surgery on Friday 12/21/07. I'm hypertensive and have a strong family history of Cardiac disease , so I did need a cardiac work-up in between there. All went well and I'm on my way to the loser's bench in less than 3 days.

GOOD LUCK :whoo:

[steph_co 9]

I didn't have any insurance advice, Bente, but wanted to wish you well with Tricare. I have heard one too many stories with them from friends still in the military (DH was HD'd in 2005 after 17 years).

The surgeon I went to did not have a problem with banding me. I thought for sure I would be scoffed at, too. My BMI was around 37 and yes, I had co-morbidities of varicose veins, joint pain, unexplained infertility, family history of diabetes and obesity on my paternal side. I only had to deal with my surgeon. No PCP and no insurance...I was self-pay.

You might get better information if you post a Tricare-specific question in the Insurance forum further down in the main forum list. Like asking people with Tricare to give their experience. Good luck! I hope you get it! Plain old diet and exercise never worked long for me, either...I need help with the maintenance part!